Hyderabad, Telangana
Job Summary

Role Summary The Senior Business Analyst will own the requirements lifecycle for the CDEx platform — translating Da Vinci Codex/HRex/PAS IG capabilities and payer-specific needs (HEDIS, RADV, prior authorization, claims attachments) into clear, testable user stories and specifications. The BA bridges payer operations, clinical/HIM teams, HIE (DBMotion) stakeholders, security, and engineering, and drives payer onboarding requirements, data mapping (C-CDA FHIR X12), and workflow definitions for solicited/unsolicited attachments, direct query, and task-based exchange. Key Responsibilities Elicit, document, and manage business and functional requirements across all six CDEx modules: Attachments & CCD Delivery, Direct Query, Task-Based Exchange, Security & Authorization, NFR/Telemetry, and the Administrative Operations UI. Analyze the Da Vinci CDex, HRex, and PAS Implementation Guides and translate conformance requirements (actors, profiles, Must Support elements, $submit-attachment operation, Task-based workflows) into user stories with acceptance criteria. Define payer onboarding requirements: subscriptions, enabled interfaces, attachment codes (LOINC / X12 PWK01), delivery preferences (secure file transfer, single-use URL, API callback), rate limits, and data-access boundaries. Produce data mapping specifications across C-CDA R2.1 (CCD sections/templates), FHIR R4 US Core resources, and X12 transactions (275/277 RFAI/278) — including DBMotion CCD enrichment rules using enterprise data sources (Patient Insights, FHIR services, DT&I; data products). Document solicited and unsolicited (event-driven)



attachment workflows, including patient-event trigger criteria (discharge, encounter status, diagnosis criteria) and reassociation of attachments to claims/prior auths via tracking identifiers. Define task lifecycle and work-queue requirements: statuses (requested accepted in progress completed/failed/rejected), ownership, due dates, SLA escalation, and exception reason codes. Partner with security and compliance teams on purpose-of-use, minimum-necessary, consent/restriction, data segmentation, and audit/traceability requirements (correlation IDs, request IDs, package IDs). Define requirements and wireframe inputs for the Administrative Operations UI: payer management, request visibility/filtering, security visibility (Entra ID sync), event trigger management, and transmission management. Support incremental delivery planning (Foundation Attachments MVP Event/Async Attachments Direct Query Task & Advanced Attachments), backlog grooming, UAT planning, and payer connectathon/partner testing coordination. Facilitate workshops with payer partners, clearinghouses, HIM/clinical operations, and engineering; manage open questions, decisions, and requirement traceability.



Required Skills & Experience 8–10 years of overall IT/business analysis experience, with 4+ years in healthcare interoperability or payer–provider data exchange programs. FHIR: Strong working knowledge of HL7 FHIR R4, US Core profiles, and Da Vinci IGs (CDex, HRex, PAS; CRD/DTR a plus) actors, profiles, operations, and Task-based exchange patterns. C-CDA R2.1: Hands-on understanding of CCD document structure, templates/sections (problems, meds, allergies, results, encounters), and document exchange workflows. EDI X12: Solid knowledge of payer-based X12 transactions — 837 claims, 275 attachments, 276/277 claim status, 277 RFAI, 278 prior authorization, 270/271 eligibility — and how they interplay with FHIR-based attachment workflows. Experience

Key Responsibilities
1. To conduct in-depth analysis to understand client needs, challenges, and opportunities, translating them into transparent and concise functional specifications.
2. To analyze available options, considering feasibility, cost, and alignment with business requirements and suggest solutions.
3. To participate and facilitate the walkthrough’ to brief the functional specification mapping to business requirements.
4. To prepare and / or aid the preparation of test cases in line with functional requirements
5. Tackle complex business problems and develop innovative solutions.

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📌 Lead Business Analyst (Hyderabad)
🏢 HCLTech
📍 Hyderabad